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Dear Provider:
Effective
for dates of service on and after September 1, 2015, Washington
Apple Health (Medicaid), administered by the Health Care Authority, will require prior authorization for
methadone.
The agency
is changing the authorization status for methadone as directed by the
Washington Medicaid Drug Utilization Review board due to concern over the high
number of methadone related fatalities in the State of Washington. The agency
will require authorization for new starts for methadone when medically
necessary, as evidenced by intolerance to or failure of all generic long-acting
opioids to treat the client’s pain.
The agency
will allow clients currently receiving methadone to continue receiving
methadone without authorization or restriction when the agency has record of
payment for methadone in the last two months.
The agency
will also continue to cover methadone without restriction for clients actively
being treated for cancer pain, using expedited authorization (EA) code
85000000040.
For clients
new to Washington Apple Health for whom the agency does not have current record
of payment for methadone, but who have been actively taking methadone paid for
out-of-pocket or by another payer, pharmacies may request authorization by
calling toll-free 866-668-1214 and indicating that the methadone is a
continuation of current treatment for the client.
For more information, see the agency’s Washington
Preferred Drug List (WPDL) and Expedited Authorization List (EA).
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